Analysis: How attempts to address high GP workloads have failed

GP workloads have been escalating for a number of years. But while pledges have been made by the Government and NHS to unlock more time for GPs, there has been little impact.

GP Forward View

In 2016, NHS England’s GP Forward View was the first time general practice workload was fully acknowledged by the NHS.

It promised a national programme, aimed at releasing time for patients, which it said would free up 10% of GPs’ working day.

This would involve focussing on 10 areas – or ‘high impact actions – including the use of new types of consultations, such as telephone and group appointments, social prescribing, developing teams of multi-professional staff members, and working in partnership with federations, community services and pharmacies.

There was also the pledge – originally made by then health secretary Jeremy Hunt in 2015 - to ensure an additional 5,000 doctors were working in general practice by 2020. Plus the commitment to bring 5,000 additional general practice staff into the workforce.

Devolved nations

Across the UK there have been plans to recruit more GPs and practice staff.

In Wales, recruitment problems have prompted the creation of additional medical school places this year, while £20,000 payment incentives have been on offer to GP trainees since 2016 to keep them working in the country.

Last year, GP practices in Northern Ireland started to receive some of a multi-million pound investment in practice-based staff such as physiotherapists, mental health specialists and social workers to bolster capacity.

In Scotland, the Government aims to increase the number of GPs by 800 over a decade – and has boosted its number of medical school places as a result. A major reform of the GP contract resulted in a focus on multi-disciplinary teams sharing GP workloads.

Failures

Unfortunately many of these changes have either not materialised – or if they have, it is not clear they have had the desired effect of reducing workload.

The jury is still out on whether online consultations save time or if they actually increase demand for appointments.

On the staffing front, it’s a well-known fact that the goal of securing an additional 5,000 GPs in England is nowhere near being achieved, with the workforce having fewer family doctors than when the target was announced.

And it will take several years before additional medical school and GP specialty training places result in extra GPs in practice.

Will the new GP contract make a difference?

The new five-year GP contract in England, funded with £1bn of core money and £1.8bn for practices to join primary care networks, does offer up some further solutions for addressing workload.

It provides money to help pay for GPs’ administrative work – by offering annual funding to help cover the costs of health data requests made by patients, after GDPR legislation removed the ability for practices to charge for this activity.

The contract also includes cash for 22,000 additional practice staff – including pharmacists, physiotherapists, paramedics, physician associates and social prescribing workers – by 2023/24.

But at first glance, the contract appears to add to practices’ immediate workload.

As a minimum it expects them to join a network and make sure it is ratified, hire additional staff for the network, and organise a GP as a clinical director.

Continued pressure

Before any long-term changes can take effect, as has already been happening across the UK, practice closures are likely to continue escalating as GPs leave and can’t be replaced.

Partners will also continue to be faced with decisions about discontinuing services and cutting routine appointments, to free up capacity.

Attracting GPs into partnership in the first place will continue to be a struggle – as many view the additional responsibility on top of already increasing workloads as being unmanageable.

As Dr Chandra Kanneganti - BMA GPC policy lead for NHS England investment - says, working hours are spiralling out of control.

‘There are no GPs to recruit. The Government has failed with GP recruitment. I start at 8am and don’t go home till 8pm. The workload is twice to three times more than it was,’ he says.

That is, unless something is done to address the situation.

Pulse’s GP workload survey

In response to these mounting challenges, Pulse is launching a GP workload survey to highlight the true scale of workload GPs are now facing.

It's a generational demographics problem. The baby boomers outnumber GenX who are currently expected to look after them. Boomers have been holding onto their careers in all sectors but they didn't plan for their healthcare needs well enough though as not enough GenX doctors entered training 20y ago - this cannot be undone. The only hope is an expansion of millennial doctors who are another large generation and will demand change.

Is there a need for another survey? The issues are all well known the problem has been with hierarchal denial.
I disagree with anon 2016. technology will not solve the NHS or GP situation. simply combining practices and adding other means of "consulting" [unless AI will take over] only adds to the problem. When really have computers lessened workload, it end up with the tail wagging the dog. unfortunately the dogs now dead. sorry. GP and patients need good people not technology that no one understands.